AB0953 THE EFFECTIVENESS OF IL-23 INHIBITORS ON AXIAL SPONDYLARTHRITIS AND AXIAL PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: S. Al Nokhatha, S. Maguire, K. Alnaqbi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Axial spondylarthritis (axSpA) is an immune-mediated systemic chronic inflammatory arthritis involving the axial skeleton that may involve peripheral joints. Nonsteroidal anti-inflammatory drugs are first line therapy in the management of axSpA, however for many patients NSAID monotherapy is not sufficient to induce disease remission. Given the known efficacy of biologics in spondyloarthritis and the heterogenicity of these conditions, treatment choices should take into account all relevant disease domains. Interleukin-23 has been identified as a promising therapeutic target in SpA and PsA based on a significant body of evidence. Interleukin 23 inhibitors have produced inconsistent results when used to treat axial spondylarthritis and axial psoriatic arthritis.(1,2) Thus, there is a need for a holistic understanding of the use of IL23 inhibitors in axial conditions in particular spondylarthritis and psoriatic arthritis to provide appropriate evidence-based management and mitigate the growing burden of these diseases. <h3>Objectives</h3> To explore the latest reported literature on the effectiveness of IL 23 inhibitors in axial spondylarthritis and psoriatic arthritis. <h3>Methods</h3> A systematic literature review was conducted. The following databases were searched: Pubmed, Mendely EMBASE, MEDLINE (OVID), CINAHL, Cochrane Library (central) and Web of Science. The search strategy included terms related to the axial spondylarthritis and axial psoriatic arthritis and specifying the medications of study interest Ustekinumab, Risankizumab, Guselkumab or Tildrakizumab. The search was restricted to studies published in English from inception until June 2022. Randomized controlled trials, observational studies, or systematic reviews were eligible. Screening of titles, abstracts, and subsequent full text assessment were conducted independently by two independent reviewers. Outcomes assessed were BASDIA, BASDAI 50,modified BASDAI, BASFI and ASDAS. <h3>Results</h3> Total of 4456 studies were identified, 9 studies of which 5 studies examining axial spondylarthritis (Four RCTs and 1 prospective study) and 4 studies examining axial psoriatic arthritis (two prospective observational studies and two post hoc-analysis) were deemed suitable for inclusion. In contrast to one prospective observational study, 4 RCT (3 ustekinumab, 1 risankizumab) did not support the use of IL23 inhibitors in axSpA based on the analyzed outcome measures of interest. Pooling of results for the three ustekinumab trials (BASDAI50, BASFI, and ASDAS) (figure 1) demonstrated that the drug was not efficacious in treating axSpA. However, trials in axial PsA investigations showed an improvement in BASDAI, modified BASDAI, and ASDAS. <h3>Conclusion</h3> The results of this meta-analysis would support the use of IL-23 inhibiting medications in the treatment of axial PsA. However, this is not the case for axSpA, as these drugs failed to demonstrate a significant improvement in patient outcomes in axSpA patient populations. This meta-analysis raises several interesting questions regarding differences in pathogenesis of axSpA and axial PsA. It also supports the need for ongoing drug development in axSpA, as biologic options remain limited compared to other forms of inflammatory arthritis. <h3>References</h3> [1]Deodhar A, Gensler LS, Sieper J, et al. Three Multicenter, Randomized, Double-Blind, Placebo-Controlled Studies Evaluating the Efficacy and Safety of Ustekinumab in Axial Spondyloarthritis. <i>Arthritis Rheumatol</i>. 2019;71(2):258-270. doi:10.1002/art.40728 [2]Mease, P.J. <i>et al.</i> (2021) "Efficacy of guselkumab on axial involvement in patients with active psoriatic arthritis and Sacroiliitis: A post-hoc analysis of the phase 3 discover-1 and discover-2 studies," <i>The Lancet Rheumatology</i>, 3(10).doi.org/10.1016/s2665-9913(21)00105-3. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.